title: Primary care closed claims experience of Massachusetts malpractice insurers.
abstract: OBJECTIVE
  Despite prior focus on high-impact inpatient cases, there are increasing data and awareness that malpractice in the outpatient setting, particularly in primary care, is a leading contributor to malpractice risk and claims.
  
  
  OBJECTIVE
  To study patterns of primary care malpractice types, causes, and outcomes as part of a Massachusetts ambulatory malpractice risk and safety improvement project.
  
  
  METHODS
  Retrospective review of pooled closed claims data of 2 malpractice carriers covering most Massachusetts physicians during a 5-year period (January 1, 2005, through December 31, 2009). Data were harmonized between the 2 insurers using a standardized taxonomy. Primary care practices in Massachusetts. All malpractice claims that involved primary care practices insured by the 2 largest insurers in the state were screened. A total of 551 claims from primary care practices were identified for the analysis.
  
  
  METHODS
  Numbers and types of claims, including whether claims involved primary care physicians or practices; classification of alleged malpractice (eg, misdiagnosis or medication error); patient diagnosis; breakdown in care process; and claim outcome (dismissed, settled, verdict for plaintiff, or verdict for defendant).
  
  
  RESULTS
  During a 5-year period there were 7224 malpractice claims of which 551 (7.7%) were from primary care practices. Allegations were related to diagnosis in 397 (72.1%), medications in 68 (12.3%), other medical treatment in 41 (7.4%), communication in 15 (2.7%), patient rights in 11 (2.0%), and patient safety or security in 8 (1.5%). Leading diagnoses were cancer (n = 190), heart diseases (n = 43), blood vessel diseases (n = 27), infections (n = 22), and stroke (n = 16). Primary care cases were significantly more likely to be settled (35.2% vs 20.5%) or result in a verdict for the plaintiff (1.6% vs 0.9%) compared with non-general medical malpractice claims (P < .001).
  
  
  CONCLUSIONS
  In Massachusetts, most primary care claims filed are related to alleged misdiagnosis. Compared with malpractice allegations in other settings, primary care ambulatory claims appear to be more difficult to defend, with more cases settled or resulting in a verdict for the plaintiff.
authors.affiliation: Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts2Center for Patient Safety Research and Practice, Division of General Internal Medicine and Primary Care, Department of Medicine, Harvard Medical School, Boston, Massachusetts.
authors.forename: Gordon D
authors.initials: GD
authors.lastname: Schiff
authors.forename: Ann Louise
authors.initials: AL
authors.lastname: Puopolo
authors.forename: Anne
authors.initials: A
authors.lastname: Huben-Kearney
authors.forename: Winnie
authors.initials: W
authors.lastname: Yu
authors.forename: Carol
authors.initials: C
authors.lastname: Keohane
authors.forename: Peggy
authors.initials: P
authors.lastname: McDonough
authors.forename: Bonnie R
authors.initials: BR
authors.lastname: Ellis
authors.forename: David W
authors.initials: DW
authors.lastname: Bates
authors.forename: Madeleine
authors.initials: M
authors.lastname: Biondolillo
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007343:Insurance Carriers / Q000706:statistics & numerical data; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D008297:Male; D008318:Malpractice / Q000706:statistics & numerical data*; D008404:Massachusetts; D019300:Medical Errors / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012189:Retrospective Studies